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advanced practice providers

A new program is empowering emergency department advanced practice providers (APPs) to practice at the top of their license, which is helping enhance the delivery of care and improve productivity, job satisfaction and clinician turnover rates at collaborating Envision Physician Services facilities.

“I am honored to receive the recognition and proud to have the opportunity to promote the successful development of APP programs,” Pelbath said. “Nurse practitioners, physician assistants and other advanced practice providers are essential to the healthcare system. When we perform the initial evaluation and advanced treatment on high-acuity patients presenting to the emergency department, we lessen the burden on physicians, improve operational efficiency and enhance the patient-caregiver experience.”

The Genesis Cup is an award for healthcare innovation presented each year by Envision Physician Services. Pelbath and Brown presented their award-winning APP STEP program, which prepares APPs to become expert emergency medicine caregivers, at the Envision Physician Services 2017 Annual Leadership Conference held in Las Vegas April 18-20.

In the emergency department, there are wide variances in APPs’ experience and capabilities. APP STEP is minimizing that gap. Providers first undergo a skills assessment for placement in one of the program’s three stages. Then, with the appropriate education and training, they advance through the program. In addition to leveraging on-site experience, the program requires advanced certification and continuing medical education training.

Together, Pelbath and Brown launched the pilot program at the beginning of 2015 at Sentara Northern Virginia Medical Center in Woodbridge, Va. Initially, nine APPs who primarily triaged and tended to patients with mild ailments and minor injuries participated in the program. Currently 21 APPS are providing the same level of care and are working in the intermediate care, acute care and observation units. Pelbath and Brown have since implemented the program in five additional Envision Physician Services sites throughout the north division with more than 50 APPs participating.

“We are committed to supporting our providers and equipping them with the tools they need to provide quality care,” Brown said. “APP STEP is easy to implement in all sites and hospital departments, and we find that our partnering facilities experience improved productivity and patient outcomes. I am extremely proud of what we have been able to accomplish and look forward to broadening the reach of the program.”

The Genesis Cup program recognizes and celebrates the creativity and innovation of everyday physicians as part of the company’s ongoing pursuit to improve the delivery of patient care. In addition to recognizing the inventor/innovator, the Genesis Cup acknowledges those involved in the initiative and the regional office supporting such endeavors.

Faced with physician recruiting challenges and a strained relationship with the community, EmCare’s team at CHI St. Luke’s Health Memorial San Augustine set out to change the culture at the 18-bed critical-access hospital, winning a national award in the process.

This fall, our team’s hard work at CHI St. Luke’s Health Memorial San Augustine in San Augustine, Texas, earned an Excellence Through Insight award for Most Improved Overall Emergency Department Experience for hospitals with less than 100 beds from Healthstream, a national third-party organization dedicated to improving patient outcomes.

The Excellence Through Insight awards recognize organizations that excel in their ability to gain insight into their patients, employees, physicians and consumers through research and to use that information to build excellence within their organization.

After analyzing the issues at San Augustine, Adam Corley, MD, an executive vice president with EmCare, suggested using seasoned, high-functioning advanced practice providers (APPs) to solve the problem, and offered to serve as the sponsoring physician via computer or mobile phone. Our team presented the concept to hospital and system administrators.

Once given the green light, Dr. Corley and Peni Russell, NP, carefully reviewed clinical candidates, focusing on those with a high skill level and a positive attitude for working with clinical staff, local providers and the community.

“The success of this initiative hinged on hiring right,” explained Dr. Corley. “Once the right clinicians were in place, the team’s mantra was to do what’s right for the patient, treat patients and their family members well, and follow best practice for clinical outcomes.”

For example, a local young adult has a unique condition that can create a great deal of pain. She has a team of doctors at the closest tertiary facility, which is two to three hours away. San Augustine has become her preferred facility for acute pain control on a frequent basis. However, staff became concerned about professional liability as the patient returned more than once in 24 hours for pain medication Russell and Darlene Williams, RN, chief executive officer, collaborated to develop a care map and order set agreed upon by Nursing and providers to provide safe care while adequately addressing the patient’s pain needs.

The San Augustine and EmCare team continues to improve quality services.

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Josh Kosowsky, M.D., FACEP

Over the past two decades, advance practice providers (APPs) have been growing both in sheer number of jobs and in their importance to the delivery of healthcare. U.S. labor statistics estimate that more than 90,000 physician assistants and 122,000 nurse practitioners are practicing today with growth rate estimates ranging from 33 percent to more than 50 percent over the next decade.i

Healthcare reform continues to drive demand for APPs, not just in primary care, but across all inpatient and outpatient specialties as organizations respond to the convergence of physician shortages, cost reductions and increased demand for services.

While healthcare organizations are expanding the roles of APPs, patients' understandings of these roles has not evolved as quickly. As leaders, we can't afford to wait for public perception to catch up. It's up to us to manage patient expectations, and in turn the patient experience, by leveraging proven communication techniques.

Nowhere is this more true than for APPs practicing in the emergency department (ED) setting. While the scope of practice for a nurse practitioner or physician assistant will vary depending on the ED, APPs play an increasingly significant role in emergency departments big and small, rural and urban, academic and community-based. Whether performing advanced triage, providing fast-track coverage, overseeing an observation/clinical-decision unit, or seeing patients alongside physicians in the main treatment area, APPs have become ubiquitous to the point where at some EDs the average patient is more likely to have contact with an APP than with a physician.

Because they often tend to see lower acuity patients, APPs have an outsized impact on the perceptions of patients who end up being discharged from the ED. And it is those discharged patients who will receive the Emergency Department Patient Experiences of Care (EDPEC) survey. Because survey questions place an emphasis on the quality of communication with providers, we need be sure that our APPs are well versed in tools and techniques such as AIDET® (Acknowledge, Introduce, Duration, Explanation, Thank You).

How can APPs make patients feel confident they are in good hands?

For a lot of patients, there is confusion and apprehension around the role of APPs within the ED care team. The AIDET® framework is proven to reduce patient anxiety and build trust with patients. In particular, AIDET® is important for APPs when it comes to "I" - Introduction.

A

Acknowledge

Provider smiles and greets the patient and family members/friends in the room.

"Good evening, Ms. Jones. Who is here with you today?"

I

Introduce

"My name is John Smith. I've been a physician assistant - or PA -in this Emergency Department since 2012. I'll be the provider taking care of you today."

If working alongside a medical doctor, either directly or indirectly, the PA would continue: "I'm working with a fabulous team, including Dr. Meltzer, the attending physician on duty today."

D

Duration

"Dr. Meltzer will be in to see you after we have your x-ray results. Typically, that takes about 45 minutes."

E

Explanation

"I want to be sure we're not missing anything, so I'm going to review your case with Dr. Meltzer and ask him to come take a look at that rash".

T

Thank You

"Thank you for trusting us to care for you."

In a less careful introduction, a patient might hear "nurse practitioner" and think "nurse," or, in the case of a physician assistant, they might hear "physician". In either instance, this confusion can impact the patient's perception of care of their entire visit. For example, it is not unusual to read survey comments from EDs that utilize APPs, where patients complain "I was never seen by a doctor" or "there were different doctors coming in and out of the room, but I couldn't tell who was in charge." These anxieties can influence a patient's overall perception of care even when their experience has been excellent in every other area.

With the increasing prevalence and expanding roles of APPs in ED settings, their impact on patients' perceptions of care will continue to grow. Focusing on key words for APPs, particularly around how they are introduced, is something you can start doing today to make a difference for your ED and for your patients.

Dr. Josh Kosowsky is coach on Studer Group's Emergency Department Services team. He is Vice Chair and Clinical Director of Emergency Medicine at Brigham & Women's Hospital in Boston and holds an appointment as Assistant Professor of Emergency Medicine at Harvard Medical School.